Pregnancy and postpartum diabetes screening falls far short of guidelines

Many fewer women are receiving screening for gestational diabetes mellitus (GDM) during pregnancy and postpartum than current guidelines recommend, a new study suggests. Researchers from Quest Diagnostics found that 68% of 924,873 pregnant women between the ages of 25 and 40 years who used the company’s services during the study period were screened for GDM. Among all pregnant women between the ages of 18 and 40 years screened for GDM, just 5% tested positive under the current American Diabetes Association/Carpenter-Coustan criteria. Nineteen percent of women with GDM were tested for diabetes within 6 months of giving birth.

“Our nationally based study demonstrates that the pregnancy and postpartum screening rates of pregnant women are much less than the recommended guidelines from the American College of Obstetrics and Gynecologists and the American Diabetes Association,” the authors write. The guidelines call for screening by history, clinical risk factors, or laboratory testing of all pregnant women who haven’t been diagnosed with diabetes and testing within 6 to 12 weeks postpartum of all women diagnosed with GDM.

The authors note that “screening for GDM is important because studies have shown that treating even mild GDM reduces morbidity for both the mother and newborn” and GDM predicts development of type 2 diabetes mellitus.

Ninety percent of all confirmatory GDM tests performed on pregnant women in the study were the 100-g oral glucose tolerance test (OGTT) recommended by the American Diabetes Association/Carpenter-Coustan criteria. The authors estimate that the number of women with GDM would have doubled had they been tested with the 75-g OGTT recommended under the new International Association of Diabetes and Pregnancy Study Groups Criteria. They conclude that adoption of the new criteria “would require a significant change in current clinical practice.”

The study was published in Obstetrics and Gynecology (2011;117;61-68).